腹腔镜下脾切除联合断流术在门静脉高压症巨脾中的临床应用  

Clinical application of laparoscopic splenectomy combined with devascularization in megalosplenia and portal hypertension

作　　者：彭沙沙 夏国兵[1] 方涛 Peng Shasha;Xia Guobing;Fang Tao(Department of Hepatobiliary and Pancreatic Surgery,Hitangshi Central Hospital,Affiliated Hospital of Hubei Polytechnic University Edong Healthcare Group,Huangshi 435000,China;Hubei Province Key Laboratory of Occupational Hazard Identification and Control,Wuhan University of Science and Technology,Wuhan 430081,China)

机构地区：[1]鄂东医疗集团黄石市中心医院,湖北理工学院附属医院肝胆胰腺外科,435000 [2]武汉科技大学职业危害识别与扌空制湖北省重点实验室,430081

出　　处：《国际外科学杂志》2021年第10期675-679,共5页International Journal of Surgery

基　　金：湖北省卫生健康科研基金资助(WJ2019H160)。

摘　　要：目的探讨门静脉高压症巨脾患者行腹腔镜下脾切除联合断流术的临床应用及疗效。方法回顾性分析2016年1月—2020年1月在鄂东医疗集团黄石市中心医院肝胆胰腺外科收治的58例门静脉高压症巨脾患者的临床资料,按手术方式不同分为腹腔镜组(n=34)和开腹组(n=24),腹腔镜组患者行腹腔镜下巨脾脏切除联合断流术,开腹组患者行开腹巨脾切除联合断流术。比较两组患者一般资料、手术时间、术中出血量、术后排气时间、术后住院时间、术后并发症(腹腔出血、B/C级胰漏、腹腔感染等)发生率。服从正态分布的计量资料采用均数±标准差(Mean±SD)表示,组间比较采用独立样本t检验;计数资料组间比较采用χ2检验或Fisher确切概率法。结果两组患者手术均成功,腹腔镜组中转开腹2例,无围手术期死亡病例。腹腔镜组手术时间为(205.3±28.6)min,开腹组为(156.4±20.7)min,腹腔镜组较开腹组延长,差异有统计学意义(P=0.012),开腹组术中出血量为(327.2±39.5)mL,显著高于腹腔镜组的(246.5±32.3)mL,两组相比差异具有统计学意义(P<0.05)。腹腔镜组患者术后排气时间及术后住院时间分别为(2.6±1.4)d、(9.7±2.3)d,开腹组分别为(3.8±1.5)d、(12.9±2.7)d,腹腔镜组均短于开腹组,两组相比差异均具有统计学意义(P<0.05)。腹腔镜组术后腹腔出血0例,B/C级胰漏2例,腹腔感染3例,开腹组术后腹腔出血1例,B/C级胰漏2例,腹腔感染5例,两组术后并发症发生率差异无统计学意义(P=0.088)。结论腹腔镜下巨脾切除联合断流术安全可行,具有创伤小、术后肠道功能恢复快、住院时间短等优点,可使患者获益,但手术难度大,对手术医师的技术及心理素质要求高。Objective To investigate the clinical application and efficacy of laparoscopic splenectomy combined with disconnection in megalosplenia and portal hypertension.Methods The clinical data of 58 patients with splenomegaly of portal hypertension treated in the Department of Hepatobiliary and Pancreatic Surgery of Huangshi Central Hospital of Eastern Hubei Medical Group from January 2016 to January 2020 were analyzed retrospectively,they were divided into laparoscopy group(n=34)and laparotomy group(n=24),Laparoscopic splenectomy combined with devascularization was performed in the laparoscopic group,and open splenectomy combined with levascularization was performed in the open group.The general data,operation time,intraoperative bleeding,postoperative exhaust time,postoperative hospital stay and the incidence of postoperative complications(abdominal bleeding,B/C pancreatic leakage,abdominal infection,etc.)were compared between the two groups.The measurement data obeying normal distribution was expressed by mean±standard deviation(Mean±SD),and the test was used comparison between groups,and the chi-square test or Fisher exact probability was used comparison between enumeration data.Results The surgery was successful in both two groups.2 cases in the laparoscopic group were converted to laparotomy,There was no death in perioperative period.The operation time of laparoscopy group was(205.3±28.6)min and that of laparotomy group was(156.4±20.7)min,which was significantly longer than that of laparotomy group(P=0.012).The intraoperative bleeding volume of laparotomy group was(327.2±39.5)mL,which was significantly higher than that of laparoscopy group(246.5±32.3)mL there was significant difference between the two groups(P<0.05).The postoperative exhaust time and postoperative hospital stay in the laparoscopic group were(2.6±1.4)d and(9.7±2.3)d,the laparotomy group were(3.8±1.5)d and(12.9±2.7)d respectively.The laparoscopy group was shorter than the laparotomy group.The difference between the two groups was statistic

关 键 词：脾切除术 腹腔镜 高血压 门静脉 巨脾 断流术 临床疗效 

分 类 号：R657.3[医药卫生—外科学]